Direct Oral Anticoagulants versus Warfarin for the Treatment of Left Ventricular Thrombus: A Multicenter Retrospective Observational Study.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2024-11-23 DOI:10.1016/j.amjcard.2024.11.026

Abdullah Al-Abcha, Shannon Clay, Ling Wang, Rohan Madhu Prasad, Mohammad Fahad Salam, Shaurya Srivastava, Manel Boumegouas, George S Abela, Yehia Saleh, Essa M Essa

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引用次数: 0

Abstract

Introduction: Vitamin K antagonists remain the mainstay of therapy in patients with left ventricular thrombus (LVT) because the efficacy of direct oral anticoagulants (DOACs) is not well established.

Methods: We performed a multicenter retrospective analysis of adults admitted between January 2015 and December 2021 and diagnosed with LV thrombus to compare the safety and efficacy of Warfarin vs DOACs. The primary outcome was thrombus resolution. Secondary outcomes included all-cause mortality, bleeding events and stroke or systemic embolism.

Results: A total of 189 patients were included. The rate of thrombus resolution was similar in patients with LVT treated with DOACs when compared to those treated with warfarin (DOACs 73.9%vs warfarin 68.5%, p=0.489). Additionally all-cause mortality (DOACs 13.04% vs warfarin 9.79%, p=0.583), bleeding events (DOACs 19.57% vs warfarin 13.99%, p=0.361), and SSE (DOACs 10.87% vs warfarin 15.38%, p=0.446) were all similar in the two groups. In the propensity matched group, 90 patients were included. Multivariate analysis showed no significant difference of using warfarin or DOACs on thrombus resolution (OR 0.94, 95% CI 0.858-1.029, p=0.18), all-cause mortality (OR 1.032, 95% CI 0.906-1.176, p=0.6354), bleeding events (OR 1.694, 95% CI 0.168-17.097, p=0.655), or SSE (OR 1.947, 95% CI 0.087-4.756, p=0.6747).

Conclusion: In our retrospective analysis, DOACs had similar efficacy and safety when compared to warfarin in the treatment of LV thrombi.

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治疗左心室血栓的直接口服抗凝剂与华法林：一项多中心回顾性观察研究。

简介：维生素 K 拮抗剂仍是左心室血栓（LVT）患者的主要治疗药物，因为直接口服抗凝剂（DOACs）的疗效尚未得到充分证实：我们对 2015 年 1 月至 2021 年 12 月期间入院并确诊为左心室血栓的成人进行了一项多中心回顾性分析，以比较华法林与 DOACs 的安全性和有效性。主要结果是血栓溶解。次要结果包括全因死亡率、出血事件、中风或全身性栓塞：结果：共纳入 189 名患者。与接受华法林治疗的患者相比，接受 DOACs 治疗的 LVT 患者血栓溶解率相似（DOACs 73.9%vs 华法林 68.5%，P=0.489）。此外，两组患者的全因死亡率（DOACs 13.04% vs 华法林 9.79%，P=0.583）、出血事件（DOACs 19.57% vs 华法林 13.99%，P=0.361）和 SSE（DOACs 10.87% vs 华法林 15.38%，P=0.446）均相似。在倾向匹配组中，纳入了 90 名患者。多变量分析显示，使用华法林或 DOACs 在血栓溶解（OR 0.94，95% CI 0.858-1.029，P=0.18）、全因死亡率（OR 1.032，95% CI 0.906-1.176，P=0.6354）、出血事件（OR 1.694，95% CI 0.168-17.097，P=0.655）或SSE（OR 1.947，95% CI 0.087-4.756，P=0.6747）.结论：在我们的回顾性分析中，与华法林相比，DOAC 在治疗左心室血栓方面具有相似的疗效和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.